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Why Gaps In Treatment Hurt Your Disability Case

Could A Gap In Treatment Hurt Your Disability Case?

Consistent and appropriate medical care is essential for an individual seeking to receive and/or maintain disability benefits. First and foremost, failing to seek treatment can have detrimental consequences for your health. Second,gaps in treatment will likely create problems for your application for disability benefits, whether Long Term Disability (LTD), Short Term Disability (STD), FERS (Federal Employee Retirement System) Disability Retirement, Social Security Disability or other disability benefits.

Central to any disability case is proving that you have a medical condition, and as a result of the symptoms and limitations from that condition, you are unable to work. Further, eligibility for Social Security Disability and most disability retirement benefits requires that the disabling condition last, or be projected to last, for an extended period, generally at least 12 months.The most essential part of building a strong case to prove eligibility for disability benefits is obtainingdocumentation of your disabling condition(s), resulting symptoms and impairments, and prognosis. The best and most reliable source of this information is medical records.

Whatever entity is making the determination about your eligibility for disability benefits will review and decide to award or deny a claim for benefits largely on the medical records.This is true whether your application is filed with a private insurance company for ERISA (Employee Retirement Income Security Act) long term disability benefits, the Office of Personnel Management for Federal Disability Retirement Benefits, or the Social Security Administration for Social Security Disability benefits. Therefore, you need to ensure your medical records show a complete picture of the scope of your medical conditions, ongoing efforts to obtain treatment, and detailed symptomology. Ideally, the records should also reflect that your doctor advised you to stop working.

In addition to treatment notes from regular doctor visits, some of the most persuasive evidence in a disability case can be a narrative report of a physician explaining how your symptoms and limitations prevent you from satisfactorily performing your occupation or any occupation, as the case may be. A gap in care reduces the likelihood that a physician or other treating professional will be able to attest to your inability to work. Without continuity of care, it is harder to build a relationship with a physician who can provide a more in-depth, longitudinal description of your medical treatment.

Gaps in treatment may also impact your eligibility for back benefits. Periods without treatment, especially if you were continuing to work during that time, can decrease the credibility of earlier statements of your inability to work. A later treatment date could be used as the benchmark for when your condition reached the point of prohibiting you from working. For example, for Social Security Disability, a break in treatment could lead to a determination of a later onset date of disability.

Even once you have been awarded disability benefits, it is crucial that you continue to seek treatment appropriate for your disability. For mental health, this means maintaining a regular relationship with a therapist and/or psychiatrist. For other disabling conditions, if you have reached a point in your healing process where you have been told that there are limited treatment options, ensure that you continue to receive treatment, as appropriate, and that your medical records clearly reflect the reason behind ceasing a particular course of treatment.

An award of disability benefits is subject to periodic review to evaluate whether you continue to qualify for the benefits you are receiving. A break in treatment can be interpreted negatively in many ways. First, it may indicate non-compliance with recommended treatment. It is essential to show that you are working with your physicians and making efforts to improve your health or quality of life, and not exaggerating or intentionally worsening your condition.

Similarly, the absence of care can be misinterpreted as a sign that the conditions that required treatment have improved to the point where they are no longer disabling. If you no longer receive medical care, it may be impossible to provide the medical records that justify continued eligibility.

There may be many reasons why you may experience gaps in care. Often, we find that our clients have complex medical needs that require treatment from multiple specialists. Scheduling numerous doctors can be a daunting task, requiring coordination of highly limited doctors’ schedules. Other more acute issues may occur- such as a family member being in a car accident- that may make long term disabling conditions seem like less of a priority. Gaps in care may also relate to the financial burden of continuing to receive regular care. Specialists and treatment are often expensive, and difficult financial choices regarding health insurance coverage options may make treatment seem impossible.

The current global health pandemic exacerbates many of these issues and may make continuous care seem even more of a daunting task. However, it is vital to continue to receive regular treatment to the best of your abilities. Options such as telemedicine appointments allow for patients and doctors to maintain appointments. Of course, at this time, it may be challenging to avoid gaps in treatment. Be sure to keep up with rescheduling and missed appointments, and ask your doctor to include information regarding attempts to reschedule and delays due to Covid-19 in your medical records.

The most important thing is to stay safe and healthy to the best of your abilities. At the law firm of Andalman and Flynn, we have over 20 years of experience helping people obtain disability benefits. Contact us today for a free consultation and to discuss how we may be able to assist you in maximizing your chances of winning an application, a review, or an appeal for disability benefits or disability retirement.

Andalman & Flynn, P.C. serves clients throughout Maryland and the District of Columbia, offering compassionate, quality service and results-driven representation across a broad range of legal areas. With a concentration on disability benefits law and family law, the firm focuses on cases that impact the rights of everyone, and they are there for clients when responsive legal help is most critical. For more information about Andalman & Flynn, please visit our website or call 301.563.6685.

The information on this website is for informational purposes only; it is deemed accurate but not guaranteed. It does not constitute professional advice. All information is subject to change at any time without notice. Contact us for complete details.